Form 20 Application for additional/change of qualified person for a contractor licence

Department of Justice and Attorney-General Electrical Safety Office Form 20 Application for additional/change of qualified person for a contractor licence V12.06-2014 Electrical Safety Act 2002 INSTRUCTIONS: Read the guidelines when completing this application form. Details of supporting documentation required are outlined in the guidelines. The guideline sections align with this form s section numbers. Section 1 - Current contractor licence details Complete these details EXACTLY as they appear on your electrical contractor licence card. Name on licence: Section 2 - Removing qualified persons Nominate the qualified person to be removed from the electrical contractor licence. Name Licence number Business Technical If you are not adding any additional qualified persons please go to section 7. Section 3 - Adding a qualified technical person/s A change to a qualified technical person s class of electrical work licence may similarly change the scope of electrical work of the contractor licence. To be completed by the nominated qualified technical person (QTP). If you require more than one QTP - copy this section and attach to application form. Please tick the appropriate box for the nominated qualified technical person who must be an employee, a member or an executive officer of the corporation, partnership or individual (choose one): An employee A member An executive officer Title: (Mr/Mrs/Ms/Miss/Other) Date of Birth: Family Name: Given Name/s: Middle Name/s: QTP History - Have you: Yes No been refused or disqualified from holding an electrical licence or registration in Queensland or any other jurisdiction? had an electrical licence or registration cancelled or suspended in Queensland or any other jurisdiction? been issued with an Improvement or Infringement Notice under the Electrical Safety Act 2002 (the Act) OR an Electrical Safety Protection Notice under the Act for which there is outstanding payment or rectification? been subject to disciplinary action under the Act or in any other jurisdiction? If you answered yes to any of the questions above, you MUST provide details and copies of all relevant documentation. Great state. Great opportunity.

To demonstrate that you are competent to be a QTP for a Queensland Electrical Contractor Licence you MUST complete 3A and the declaration at 3I - PLUS one of the following 3B, 3C, 3D, 3E, 3F, 3G or 3H (if applicable): 3A I hold a current Australian or New Zealand electrical work licence: Date initial licence issued: Where issued: Expiry date: Licence category: Licence held for more than one year but not more than five years from the initial licence issue date. (If you have a current non-queensland electrical licence you must attach a verified copy of your current licence, permit, certificate or other authority and a signed mutual recognition statutory declaration available from the Electrical Safety Office website www.electricalsafety.qld.gov.au). 3B 3C I have held my initial licence for more than 1 year and less than 5 years (do not include licences where Mutual Recognition was deemed). If less than 12 months go to 3C or more than 5 years go to 3G. I have training and 3 years electrical contracting experience in a country other than Australia and New Zealand and I have held my Queensland electrical work licence for less than 1 year and require special consideration. 3D I am currently the QTP for a Queensland electrical contractor/s licence. Name on contractor licence: Expiry date: 3E I have been the QTP for a Queensland electrical contractor licence within the past 5 years. Name on contractor licence: Expiry date: 3F I am currently the QTP for a non-queensland electrical contractor licence. Name on contractor licence: Expiry date: Where issued: Provide details of the electrical contractor licence you have identified above (if you have a current non-queensland electrical licence you must attach a verified copy of your current licence, permit, certificate or other authority and a signed mutual recognition statutory declaration). 3G I have held a Queensland electrical work licence for more than 5 years from the initial date of issue and within the last 5 years have completed the course indicated below (for installation only) (Please tick one box only - verified copies of course results must accompany this application). Course names can be found in the guidelines - section 3G. UEENEEG197* UEENEEG005* / UEENEEG105* 39093QLD & CNQ35E Part 2 39093QLD & EA103 39093QLD & CNQ35C QEE010 & CNQ35E Part 2 QEE010 & EA103 QEE010 & CNQ35C Other: (please specify) Date completed: * An alpha identifier may be attached to the course number (see guidelines for more information) I do not have an electrical work licence. I am not required to hold an electrical work licence under the Electrical Safety Act 2002 3H (attach verified evidence of your competence to perform electrical work within the scope of the electrical contractor licence). Applicants under 3H are applying for a Restricted Electrical Contractor Licence that does NOT permit installation work. Nominate the circumstances in which you will perform electrical work: As an electrical engineer Testing electrical equipment used in workplaces or electrical equipment make available for hire. UEENEEP026* / UEENEEP008* for Test and Tag. (verified copies of course results must accompany this application). I have satisfactorily finished the required courses of instruction/examination. Name of course: Date of completion: 3I DECLARATION - THE QTP MUST COMPLETE THE FOLLOWING A Qualified Technical Person must either be a member, an employee or an executive officer of the business entity applicant. I am a fit and proper person. I am competent to perform the technical aspects of performing electrical work as, or for, a licensed electrical contractor. I agree to be the nominated qualified technical person for the applicant. The information provided by me for this application is true and correct to the best of my knowledge. I am aware that I should inform the Department of Justice and Attorney-General if I cease to be the qualified technical person or no longer wish to be the qualified technical person for this contractor licence. Signature: Date: Form 20 - Application for additional/change of qualified person for a contractor licence ABN 13 846 673 994 2/10

Section 4 - Proof of identification for the Qualified Technical Person If you have previously held a Queensland contractor, electrical work licence or permit go to section 5. If you have not previously held a Queensland contractor, electrical work licence or permit then you will need to provide 100 points of identification. Please identify which documents you have used to prove your identity by ticking the relevant items below: Birth or citizen certificate (only one) (70) Passport (70) ID card issued to a public employee (40) ID card issued by Centrelink (40) Driver s licence (40) Confirmation from employer (35) Store or Medicare card (25) Club membership card (25) Debit/credit card (one per financial institution) (25) Declaration by the authorised person: I am the authorised person (refer to guidelines) to complete this declaration and I have sighted original copies of the documents indicated in the document list above. The applicant has achieved 100 identification points and I am satisfied as to the person s identity. Occupation: (As selected from the Name: (Please print) approved list in the guidelines) Signature: Contact number: Section 5 - Qualified Business Person To be completed by the nominated qualified business person (QBP). If you require more than one QBP - copy this section and attach to application form. Please tick the appropriate box for the nominated qualified business person who must be an employee, a member or an executive officer of the corporation, partnership or individual (choose one): An employee A member An executive officer Title: (Mr/Mrs/Ms/Miss/Other) Date of Birth: Family Name: Given Name/s: Middle Name/s: QBP History - Have you: Yes No ever become bankrupt, or entered into a debt agreement under Part IX of the Bankruptcy Act 1966? ever entered into a composition, deed of arrangement or deed of assignment - Part X of the Bankruptcy Act 1966? if yes, been discharged lawfully from bankruptcy? Date of discharge: ever been a director ora manager of a company which is subject to a winding up order, placed in receivership or administration, or under official management, had a controller appointed, or entered into other arrangements with creditors due to insolvency? been convicted of any criminal offence (excluding traffic offences) relating to honesty within the last ten years e.g fraud or stealing? been convicted of an offence under section 596 of the Corporations Act 2001 (Commonwealth)? ever been disciplined by any Committee, Tribunal or Court in relation to the performance of electrical work in Queensland or any other jurisdiction? ever had a pending or current disciplinary proceeding by any Committee, Tribunal or Court in relation to the performance of electrical work in Queensland or any other jurisdiction? IMPORTANT If you answer YES to any questions below, you MUST give details and provide copies of all relevant documentation. To demonstrate that you are competent to be a QBP for a contractor licence you must satisfy ONE of the following appropriate sections 5A, 5B, 5C or 5D and the declaration at 5E: 5A I have satisfactorily finished the required course/s of instruction/examination within the last 5 years (please tick one box only): (verified copies of course results must accompany this application). UEENEEG075* / UEENEEG014* / UEENEEG175* CNQ35E Parts 2 & 3 EA102, EA103 & EA105 BSBSMB401* CNQ35C Date completed: Alternative course for consideration of the regulator - which I believe is the equivalent of one of the courses above. Name of course: Date completed: * An alpha identifier may be attached to the course number (see guidelines for more information) Form 20 - Application for additional/change of qualified person for a contractor licence ABN 13 846 673 994 3/10

I have been operating a business for a period of, or periods totalling, 5 years (provide evidence of your competence to perform the 5B business aspects of operating an electrical contracting business). Acceptable evidence includes a statutory declaration from an accountant, employer or other business officer stating that you have been responsible for operating a business for a period not less than 5 years. I have attached the appropriate evidence of my business experience. 5C I have been a QBP for a Queensland electrical contractor licence within the last 5 years. Name on contractor licence: Expiry: I am a qualified person for a non-queensland electrical contractor licence competent to perform the business aspects of 5D performing electrical work as, or for, a licensed electrical contractor. You will need to provide evidence and a signed mutual recognition statutory declaration (available from the Electrical Safety Office website: www.electricalsafety.qld.gov.au). Please provide details of the electrical contractor licence you identified: Name on contractor licence: Where issued: Expiry: 5E DECLARATION - THE QBP MUST COMPLETE THE FOLLOWING A Qualified Business Person must either be a member, an employee or an executive officer of the business entity applicant. I am a fit and proper person. I am competent to perform the business aspects of performing electrical work as, or for, a licensed electrical contractor. I agree to be the nominated qualified business person for the applicant. The information provided by me for this application is true and correct to the best of my knowledge. I am aware that I should inform the Department of Justice and Attorney-General if I cease to be the qualified business person or no longer wish to be the qualified business person for this contractor licence. Signature: Date: Section 6 - Proof of Identification for the Qualified Business Person If you have previously held a Queensland contractors licence, electrical work licence or permit or have completed the proof of identification under section 4 go to section 7. If you have never held a Queensland contractor, electrical work licence or permit then you will need to provide 100 points of identification. Please identify which documents you have used to prove your identity by ticking the relevant items below: Birth or citizen certificate (only one) (70) Passport (70) ID card issued to a public employee (40) ID card issued by Centrelink (40) Driver s licence (40) Confirmation from employer (35) Store or Medicare card (25) Club membership card (25) Debit/credit card (one per financial institution) (25) Declaration by the authorised person: I am the authorised person (refer to guidelines) to complete this declaration and I have sighted original copies of the documents indicated in the document list above. The applicant has achieved 100 identification points and I am satisfied as to the person s identity. Name: (Please print) Signature: Occupation: (As selected from the approved list in the guidelines) Contact number: Form 20 - Application for additional/change of qualified person for a contractor licence ABN 13 846 673 994 4/10

Section 7 - Declaration An un-witnessed declaration WILL NOT be accepted. Complete the details of the applicant or the person authorised to complete this form on behalf of the applicant. This person will also be the contact person for this licence. All written correspondence will be sent and addressed to this person via the electrical contractor s postal address. Title: Mr / Mrs / Ms / Miss / Other Family name: Given name/s: Middle name/s: Complete the following contact details if details are different to those registered. Contact number: Email: I am the applicant or am authorised by the applicant to sign this application. The applicant meets the eligibility requirements for an electrical contractor licence under the Electrical Safety Regulation 2013. If issued an electrical contractor licence the applicant will continue to meet the eligibility requirements for this licence, including the requirement to have a person or persons qualified as a business person and a technical person. I declare that the information contained in this application and all attachments are true and correct to the best of my knowledge. Signature: Date: Witness Name: Witness Signature: Date: Note: The Department of Justice and Attorney-General may request you to provide evidence in support of this declaration. There are substantial penalties under the Electrical Safety Act 2002 for making a statement to the department or providing a document to the department that you know is false or misleading in any material particular. Also supplying incorrect or misleading information and failing to comply with the eligibility requirements throughout the term of the licence are grounds for disciplinary action. Section 8 - Lodging this form Please return to: Department of Justice and Attorney-General Electrical Safety Office Licence Processing Services PO Box 820 Lutwyche QLD 4030 or Fax: (07) 3874 7670 Privacy statement: The Department of Justice and Attorney-General is collecting your personal information in order to process your application to add, change or delete a qualified person from an electrical contractor licence in accordance with the Electrical Safety Act 2002. The department may be required to disclose your personal information to the prescribed electricity entities in Queensland and other Australian and New Zealand electrical regulators or as otherwise required by law. Your information will be disclosed to a third party contractor to print and send you your licence card, and licence renewal requests. This information may also be used to provide you with electrical safety updates, for auditing purposes, for statistical research, evaluation and reporting of our services. This includes publishing your licence details on the department s online register which is accessible by the public. Form 20 - Application for additional/change of qualified person for a contractor licence ABN 13 846 673 994 5/10

Form 20 Guideline for an additional/change of a qualified person for a contractor licence This guide is designed to assist you with your application to add, change or delete a qualified person from an electrical contractor licence. Reading and following these guidelines will ensure your application is completed correctly, reducing possible delays in processing. You must ensure that your nominated technical and business persons meet the eligibility requirements before submitting your application. An incorrect or incomplete application may be considered as withdrawn. The application form The application form must be the current version of the Application for additional/change of qualified person for a contractor licence (form 20). See www.electricalsafety.qld.gov.au. Section 1 - Current licence details Provide the name and number of the electrical contractor licence for which the qualified person details are to be altered. Write these details exactly as they appear on your contractor licence. Section 2 - Removing qualified person Write down the name of the qualified person to be removed from the electrical contractor licence and tick the box on the left to confirm their removal. If the person to be removed is a qualified technical person required to hold an electrical work licence for the contracting work you will also need to write that work licence number in the space provided to the right of the name. You must also tick the box to indicate if the qualified person to be removed is a qualified technical or qualified business person. Note that changes to your qualified technical person may affect the operation of your contractor licence unless the new qualified technical person has the same licence endorsement and has completed the required courses of instruction. For example, if your licence had no restrictions and your qualified technical person was an electrical mechanic and you replace them with an electrical fitter, this would change the scope of your contractor licence and you would need to apply for new contractor licence. Section 3 - Qualified Technical Persons (QTP) In these sections you will provide details of your nominated qualified technical person/s. Each electrical contractor licence must have at least one QTP (section 48 of the Electrical Safety Regulation 2013). The technical and business persons can be the same person. In this case, they must complete both sections 3 and 5, but only need to complete the proof of identity (if required) once. Under section 7 of the Electrical Safety Regulation 2013 the QTP must be either an employee of the electrical contractor, a member of the partnership, or an executive officer of the corporation. Only people in these positions can be nominated as a qualified person. All electrical work must be performed or supervised by a qualified technical person. (The definition of supervise as per the Electrical Safety Act 2002 is:- supervise, electrical work, means supervise the way the electrical work is performed.) The person nominated as the QTP for this application must complete sections 3 and 4. If more than one QTP is nominated copy these sections and attach them to the form. Write the personal details of the QTP, including the date of birth, in the space provided. To be approved as a QTP for the electrical contractor licence you must be: Licensed or competent to perform electrical work (within the scope of the work contracting for); and Be competent to perform the role of a qualified technical person for a Queensland electrical contractor licence. Qualified technical person history Please tick the yes or no box as appropriate and complete the remainder of the form. If you mark any of the following questions in this section as yes, you MUST give details and provide copies of all relevant documentation. Please note this information is to be used for assessment purposes only. You must satisfy one of these options to show that you hold the appropriate licence or are competent to perform electrical work for which you are not legally required to hold a licence. A person holding an Interstate or New Zealand electrical installation licence can be a QTP on a Queensland Contractor licence. Form 20 - Guideline for application additional/change of qualified person for a contractor licence ABN 13 846 673 994 6/10

Section 3A AND 3F You hold a current Australian/Interstate or New Zealand electrical work licence. All licence holders must provide the details of their licence and the length of time the licence has been held. Non-Queensland licence holders must also attach a verified copy of their licence to this application together with a signed mutual recognition statutory declaration to authorise a licence check with the jurisdiction which issued the licence. (Statutory Declaration forms can be located at www.electricalsafety.qld.gov.au). QTP for an installation electrical contractor licence, if you have held your initial electrical mechanic qualification based electrical work licence for more than 5 years, refer to 3G for recognised course requirements and complete this section. QTP for a non-installation electrical contractor licence, enter your details in sections 3A and 3F. Section 3B Eligibility for the qualified technical person may be achieved if your initial issued licence, from completion of your trade, was issued more than 1 year and less than 5 years ago. This does not include Queensland licences issued under mutual recognition. If your initial licence was issued more than 5 years ago a course of instruction must be completed. See 3G. Section 3C Documents to satisfy this requirement include, but are not limited to: Applicable sections of the appropriate Legislation/Regulation from that country; and/or Licence, qualification, competency or authority that authorises the performance of the scope of work in that country. Section 3D The QTP must be either an employee of the electrical contractor, a member of the partnership, or an executive officer of the corporation. You need to provide QTP eligibility criteria for the electrical contractor licence for which you are applying. Where you intend to be the QTP for more than one electrical contractor licence, contact the Principal Licensing Officer on 1300 362 320. Section 3G If you have held your electrical worker licence for more than five years, you will need to demonstrate current competency to act in the QTP role by completing a course of instruction approved by the regulator. Where you have satisfactorily completed these approved courses, the qualification, statement of attainment or certificate issued and signed by a Supervising Registered Training Organisation (SRTO) must be dated within the last five years. You must provide verified copies of your course results demonstrating how you meet this requirement. Where you have satisfactorily completed other licensing courses within the past five years contact the Principal Licensing Officer on 1300 362 320 to discuss your circumstances. Approved courses include: UEENEEG197* - Apply Currency of Safe Working Practices and Compliance Verification of Electrical Installations (installation) UEENEEG005* / UEENEEG105* - Verify Compliance and Functionality of General Electrical Installations (installation) QEE010 - Electrical Requirements 39093QLD - Electrical Installations Inspection and Testing EA103 - General Legislative Requirements CNQ35C - Electrical Contractors Management Skills CNQ35E Part 2 - Small Business and the Law in Queensland * An alpha identifier may be attached to the course number and typically identifies a particular version of a course (e.g. UEENEEG197A). Section 3H You must satisfy that you are competent to perform electrical work for which you are not legally required to hold a licence. Licence category includes both Test and Tag and Electrical Engineers. A person holding a current Queensland restricted electrical work licence that authorises the testing of equipment for which a Test and Tag Contractor licence is necessary, is not required to complete UEENEEP026* / UEENEEP008* - Conduct in-service safety testing of electrical cord equipment - unless you have held your restricted electrical work licence for MORE than five years. Persons who do not hold the appropriate restricted electrical work licence are required to complete Course UEENEEP026* / UEENEEP008* - Conduct in-service safety testing of electrical cord equipment. You must provide verified copies of your course results demonstrating how you meet this requirement. * An alpha identifier may be attached to the course number and typically identifies a particular version of a course (e.g. UEENEEP008A). Form 20 - Guideline for application additional/change of qualified person for a contractor licence ABN 13 846 673 994 7/10

Section 4 - Proof of identification - qualified technical person If you have indicated that you hold a Queensland electrical work licence then you do not need to complete this section. Make sure you have provided your licence number at the start of section 3. If you are applying to be the qualified technical person for a contractor licence and have never held a Queensland electrical work licence then you will need to provide proof of identification. Your personal details must be supported by 100 points of identification utilising the documents and points nominated on the form. Persons authorised to complete the proof of identity are listed below and the person must tick the relevant boxes to indicate the documents provided by you to prove your identity then print and sign their name and provide a contact number and occupation details on the application form. Accountants (registered members of the Institute of Chartered Accountants in Australia, the Australian Society of Certified Practising Accountants or the National Institute of Accountants) Bank managers Barristers, solicitors or judges Clerks of the courts Commissioner for Declarations Commissioned officers currently serving in the regular defence forces Elected representatives of federal, state and territory parliaments and municipal, regional or shire councils Holders of statutory offices for which an annual salary is payable Justice of the Peace Police officers Postal managers Public servants (current full-time employee of commonwealth, state, territory or local government or statutory authorities, who have been employed continuously for at least five (5) years by their current employer) Section 5 - Qualified business person (QBP) In these sections you will provide details of your nominated qualified business person/s. Each electrical contractor licence must have at least one QBP (section 48 of the Electrical Safety Regulation 2013). The QTP and QBP can be the same person. In this case, the nominated person must complete both sections 3 and 5, but will only need to complete the proof of identity (if required) once. Under section 7 of the Electrical Safety Regulation 2013 the QBP must be either an employee of the electrical contractor, a member of the partnership, or an executive officer of the corporation. Only people in these positions can be nominated as a qualified business person. The person nominated as the QBP for this application must complete sections 5 and 6. If you have more than one QBP, copy these sections and attach them to the form. Write the personal details of the QBP, including the date of birth, in the space provided. To be approved as a QBP for an electrical contractor licence you will need to demonstrate that you are competent to perform the business aspects of operating an electrical contracting business. Qualified business person history Please tick the yes or no box as appropriate and complete the remainder of the form. If you mark any of the following questions in this section as yes, you MUST give details and provide copies of all relevant documentation. Please note this information is to be used for assessment purposes only. You have the following options to demonstrate your competence: Section 5A You will need to provide a verified copy of your qualification, a statement of attainment or certificate issued and signed by a Supervising Registered Training Organisation (SRTO) dated within the past five years. When the completion date of the course is greater than five years prior to application for a contractor licence, the applicant may need to establish competency in accordance with section 7(1)(c) of the Electrical Safety Regulation 2013. Evidence of another appropriate business qualification, such as a business diploma or an accounting degree, with the equivalent learning outcomes in legislative frameworks and responsibilities. You must provide verified copies of your course results demonstrating how you meet this requirement. Form 20 - Guideline for application additional/change of qualified person for a contractor licence ABN 13 846 673 994 8/10

Approved courses include: BSBSMB401* - Establish Legal & Risk Management Requirements for Small Business UEENEEG075* / UEENEEG014* / UEENEEG175* - Develop Plans and Compliance policies to conduct a Contracting Business CNQ35C - Electrical Contractors Management Skills CNQ35E Parts 2 & 3 - Small Business and the Law in Queensland EA102 - Establishing Contracting Business AND EA103 - General Legislative Requirements AND EA105 - Finance & Controlling * An alpha identifier may be attached to the course number and typically identifies a particular version of a course (e.g. BSBSMB401A). Section 5B You have been operating a business for a period of, or periods totalling five years. You will need to provide evidence of your competence to perform the business aspects of operating an electrical contracting business. Acceptable evidence includes a statutory declaration from accountant, employer, or other business officer stating that you have been responsible for the operating of a business. For a self-employed person, acceptable evidence includes; business tax returns or a statutory declaration from an accountant stating that you have been responsible for the operating of a business. OR Section 5C You were a qualified business person for a Queensland electrical contractor licence within the last five years. You must provide details of the electrical contractor licence in the space provided. OR Section 5D A person holding an Interstate or New Zealand electrical contractor licence can be a QBP for a Queensland electrical contractor licence. All licence holders must provide the details of their licence. Non-Queensland licence holders must also attach a verified copy of their licence to this application together with a signed mutual recognition statutory declaration to authorise licence check with the jurisdiction which issued the licence (Statutory Declaration forms can be located at www.electricalsafety.qld.gov.au). Section 6 - Proof of identification - qualified business person You do not have to complete this section if: you have already established your identity as the qualified technical person, or if you have held or currently hold a Queensland electrical work licence. If you are applying to be the qualified business person for a contractor licence and have never held a Queensland electrical work licence then you will need to provide proof of identification. Your personal details must be supported by 100 points of identification utilising the documents and points nominated on the form. Persons authorised to complete the proof of identity are listed below. The authorised person must tick the relevant boxes to indicate the documents provided by you to prove your identity then print and sign their name and provide a contact phone number and their occupation details (as selected from the list below) on the application form. Accountants (registered members of the Institute of Chartered Accountants in Australia, the Australian Society of Certified Practising Accountants or the National Institute of Accountants) Bank managers Barristers, solicitors or judges Clerks of the courts Commissioner for Declarations Commissioned officers currently serving in the regular defence forces Elected representatives of federal, state and territory parliaments and municipal, regional or shire councils Holders of statutory offices for which an annual salary is payable Justice of the Peace Police officers Postal managers Public servants (current full-time employee of commonwealth, state, territory or local government or statutory authorities, who have been employed continuously for at least five (5) years by their current employer). Form 20 - Guideline for application additional/change of qualified person for a contractor licence ABN 13 846 673 994 9/10

Section 7 - Declaration You must sign in the presence of a witness the declaration on the form to accept the terms and conditions of the application. The witness may be any person older than 18 years of age and they must sign and complete the appropriate section after you have completed and signed the form. The department may request you to provide evidence in support of any information you have provided in the application. By signing the application form you are declaring that all of the information provided on the form is true and correct to the best of your knowledge, and that you will maintain the eligibility requirements for the duration of the licence. The declaration can be made by either the applicant or a person authorised by the applicant to sign the declaration (e.g. if the applicant is a corporation the person authorised to sign the declaration is an authorised director of the corporation). It is important to provide details of the person who signs the application form since all written correspondence for the contractor will be addressed to this person. There are substantial penalties under the Electrical Safety Act 2002 for making a statement to the department that you know is false or misleading in any material particular. Section 8 - Lodging this form Send the completed application and all supporting documentation to the postal or fax address provided. Providing documentation Documentation in support of your application, e.g. evidence of competency where required, should be sent with your application. You must provide copies that have been verified or certified. A copy can be certified by a Justice of the Peace (qualified) or a Commissioner of Declarations, or verified by an authorised officer using the department s Document Declaration form, available on the Electrical Safety Office website www.electricalsafety.qld.gov.au. Electrical Safety Office audits In the interests of electrical safety the Electrical Safety Office is conducting random licence application audits to ensure that applicants are complying with the legislation. In the event of an audit you will be required to provide certified/verified evidence as detailed on your application. Application checklist Current contractor licence details provided If removing qualified persons details provided including whether business or technical Details of additional qualified technical person provided Qualified technical person s competence indicated and evidence attached QTP proof of identity completed where appropriate and declaration signed by authorised person Details of additional qualified business person provided Qualified business person s competence indicated and evidence attached Contact and address details are correct QBP proof of identity completed where appropriate and declaration signed by authorised person Declaration signed by nominated person and signature of witness completed Application for review or appeal of decision Under section 168 of the Electrical Safety Act 2002 (the Act) a person (including a corporation or body corporate), whose interests are affected by a licensing decision can apply for a review of that decision. Under section 172 of the Act a person (including a corporation or body corporate), whose interests are affected by a disciplinary decision, original decision or review decision may appeal against the decision to the Queensland Civil and Administrative Tribunal (QCAT). Need more information? Contact: Electrical Safety Office Licence Processing Services, Department of Justice and Attorney- General. Telephone: 1300 362 320 (within Australia) Telephone: (07) 3225 2556 (outside Australia) Facsimile: (07) 3874 7670 Website: www.electricalsafety.qld.gov.au Email: LPS@justice.qld.gov.au State of Queensland (Department of Justice and Attorney-General) 2014 AEU 14/5166 Electrical Safety Office www.electricalsafety.qld.gov.au 1300 362 320 Form 20 - Guideline for application additional/change of qualified person for a contractor licence ABN 13 846 673 994 10/10